In this episode, we highlight two companies that leverage data from many different sources to create a more complete picture of a person’s health. The ultimate goal? Shifting away from the current model of “sick care” - where patients primarily see their doctors when they aren’t feeling well – to care models that prioritize long-term health and self-management with guidance from providers. These companies are helping lead the way to value-based care, from using AI to sift through patient-reported data and provide actionable insights, to integrating NCQA's HEDIS measurements into their data platform, thereby putting quality at the center of everything they do. Here, you’ll get a glimpse into the challenges and opportunities in our current data-rich health care ecosystem.The episode begins with a conversation with leaders from Welldoc. Welldoc is a health tech company developing patient-facing apps to support self-management of chronic conditions. Using an omnichannel approach, their apps gather as much data as possible from sources including remote monitoring devices, like wearables, and clinical data.Chief Analytics Officer, Dr. Anand Iyer, and Chief Medical Officer, Dr. Mansur Shomali, explain how Welldoc uses AI to parse the patient information, ultimately helping doctors and patients work together to construct an effective path to wellness.Jessica Robinson is Chief Platform Officer for health care digital developer The Garage. Jessica manages all aspects of the product life cycle, from the spark of innovation through design, development, testing, and roll-out. Founded in 2012, The Garage aims to utilize digital tools to help providers shift from fee for service models to value-based models of care.In this interview, recorded live at NCQA’s 2023 Health Innovation Summit, Jessica explains how The Garage works with Management Service and Accountable Care organizations, among other provider groups, to develop digital applications that help clinically integrated networks across 34 states harness the full extent of the population data available to them. The Garage also utilize NCQA’s HEDIS measures into their platform, allowing networks to visualize the full patient care team across the entire care continuum and deliver optimized quality care to their patients.For information on NCQA’s Health Equity Forum, click here: https://events.ncqa.org/healthequityforum

The course of the Digitalization of Health doesn’t always run smooth. But for every set of pain points a provider might experience, there are companies developing technological solutions – platforms and tools – that not only guide us through digital transformation but identify crucial patient and population data along the way.In this episode, we talk with two health tech leaders, interviewed during NCQA’s 2023 Health Innovation Summit in Orlando, Florida, about their strategies and successes in using digital tools that can ultimately reveal and resolve gaps in health care delivery.Sebastian Seiguer, is co-founder and CEO of Scene Health. Scene Health is a company focused on medication “engagement”, a comprehensive approach that means more than just getting patients to take their medicine. They provide personalized medication support by combining video technology, clinical coaching, and validated interventions to improve medication adherence rates. Within the tapestry of their mission is the clear goal of reaching and engaging with diverse, vulnerable, and hard-to-reach populations.Upendra Patel, CEO of AaNeel Infotech, is finding ways to support clinicians through EHR, or Electronic Health Record, interoperability. AaNeel Infotech worked with Medstar Health to transform an isolated risk calculator into a FHIR-based app. Upendra’s company helped them use the SMART on FHIR methodology. That’s FHIR as in “Fast Health Interoperability Resources” and SMART as in “Substitutable Medical Applications and Reusable Technologies”. Using the SMART on FHIR approach, AaNeel Infotech helped create an app called “Mobilizing a Million Hearts”, which integrates the Million Hearts Longitudinal Atherosclerotic Cardiovascular Disease risk calculator into the MedStar Health EHR system and allows Medstar providers to get an even more comprehensive view of their patients at risk for cardiovascular disease.

This episode of “Inside Health Care: a Podcast by NCQA” features three interviews recorded live at our Health Innovation Summit in October 2023. Among many panels and presentations was an incredible session titled “Health Equity Trailblazers: Where Vision Meets Commitment.” Health equity leaders discussed their organizations’ health equity strategies, vision and lessons learned, delving into how leaders can commit to and advance health equity priorities. Each of this episode’s guests sat on that panel then sat with me for a deeper dive. These leaders, each in their own way, want to inspire us to action.Dr. Joneigh Khaldun is Vice President and Chief Health Equity Officer for CVS Health. In this role, she advances the company’s data-driven strategy to improve access to services, address social determinants of health and decrease health disparities. She is a sought-after speaker and thought leader who has appeared on Meet the Press, MSNBC and CNN, among others, and she has testified before Congress.In her past work, as the top doctor leading Michigan’s COVID response, she is credited with the state’s early identification of and actions to decrease disparities, and in 2021 was appointed by President Biden to the national COVID-19 Health Equity Task Force. She is a practicing emergency physician who earned her MD from the Perelman School of Medicine at the University of Pennsylvania.Dr. Ronald M. Wyatt is a renowned global health care quality and safety expert with a passion for advancing health equity worldwide. Dr. Wyatt is Founder and CEO of Achieving Health Equity, LLC. As a distinguished Senior Fellow with the Institute for Healthcare Improvement, he holds pivotal roles as Chief Science Officer and Chief Medical Officer at the Society to Improve Diagnosis in Medicine, an organization dedicated to enhancing diagnostic accuracy in health care. As an expert in hospital safety oversight, Dr. Wyatt holds a significant role in shaping the National Patient Safety Goal on Health Equity. His contributions to the National Patient Safety Plan, authored by AHRQ and IHI, underscore his commitment to advancing health care on a global scale.Dr. Bryan O. Buckley moderated the Health Care Trailblazers panel at NCQA’s 2nd annual Health Innovation Summit. Dr. Buckley is NCQA’s Director for Health Equity Initiatives. In this position, he plays a key role in developing partnerships with funding and research organizations, care delivery systems, the managed care industry and communities to translate research knowledge and real-world evidence into development of equity-oriented products and programs. These include NCQA’s Health Equity Accreditation programs.

In this Inside Health Care interview, we explore GME — graduate medical education — and explore a few fundamental questions. How can we make sure today’s medical residents are paying attention to their patients? How do we teach residents to ask the right questions? And even more fundamentally, how do we make sure that the next generation of clinicians knows how to implement value-based models of care in order to focus on person-centered outcomes?A value-based model helps patients envision what their lives could be a few months, or even years, down the line. And that’s the point at which clinicians can help patients develop a treatment plan to get them from point A to point B. That may be the best way to keep a patient healthy, boost their interest in their self-care and prevent repeat visits for the same problem.So the questions stand regarding graduate medical education. How do you teach med school students the value of quality? How do you train them to follow a model of value-based care? And if your hospital’s HEDIS scores are low, how much of that is because of the residents? What's the correlation between medical residencies and health care quality?Michael Kanter, MD, is a professor and chair of Clinical Science at the Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, California. In his work within Kaiser Permanente’s health care system, he’s overseen the quality of care provided by 22,000 physicians to 12.2 million patients. He also was responsible for development of Kaiser’s national quality strategy. An expert in patient safety and clinical quality, he developed policy-based and software-based programs that decreased the number of missed or delayed diagnoses and increased patient engagement.Jung Kim, PhD, MPH, is Assistant Professor for Health Systems Science at the Kaiser Permanente Tyson School of Medicine, and a protégé of Dr. Kanter. Dr. Kim explores approaches to health care and healing, including studies on the roles of acupuncture and other East Asian practices as complementary or alternative medical treatments for cancer, H-I-V and other conditions. As we’ll hear in our interview, Dr. Kim also investigates innovations in medical education residency programs, including analysis of email communication among medical students and new learning strategies for medical education.

We close 2023 with our annual year-end State of Health Care interview with NCQA President Peggy O’Kane. In this interview, Peggy talks with Vice President for Public Policy and External Relations, Frank Micciche, about NCQA’s progress in 2023—both in improving equitable access to health care and implementing digital transformation across the ecosystem. As you’ll hear, we’re hitting the ground running in 2024. With new digital products, digital quality implementers and digital solutions to reveal—and reverse—health care disparities, NCQA stands ready to take the lead on advancing quality for everyone.Don't forget to sign up for NCQA’s next big event: the Health Equity Forum, coming up March 4th and 5th, 2024, at the Westin Los Angeles Airport. The Health Equity Forum convenes state officials, advocates and health care providers, showcasing the blueprint for creating and implementing statewide health equity strategies. Our next Quality Talks event is planned for Spring 2024. And as mentioned in this episode's interview, go to www.ncqasummit.com to learn more about our Health Innovation Summit, and click here to register for our next event, October 31-November 2, 2024, in Nashville.

In this episode of our “Inside Health Care” podcast, we hear two interviews that each demonstrate how close we are to solving the challenges of health disparities and digital transformation. Our first interview finds a real-life, “Last Mile” solution that will bring historically under-served populations to the health care services they need and deserve. Our second interview reveals how improved efficiencies in digitalization actually make it easier to add even more data – and more data crunching – into the mix. PHIT4DC stands for the Public Health Informatics and Technology for the District of Columbia Workforce Diversification Program. PHIT4DC brings together public health programs at two HBCUs—historically Black Colleges and Universities—namely, the University of the District of Columbia and Howard University. Together, these esteemed institutions train professionals from historically under-served neighborhoods in 21st-century IT knowledge and skills so they can return to their neighborhoods and give back to their communities.PHIT4DC trains PCMH professionals in order to send them to work in and support their hometown communities and neighborhoods. It’s a powerful solution for bridging the gap in health equity provision. And it’s probably possible to set up this model in any U.S. city. But, as you can imagine, it’s no small feat. Dr. Mary Awuonda currently serves as an Associate Professor and Director of the Center of Excellence at the Howard University College of Pharmacy. In her directorship role, she helps the College advance its health care workforce diversification mission and student academic success initiatives. She is published in the areas of minority health, health disparities, health outcomes research and workforce diversification. Hannah George is a health care consultant with years of service across the health care industry. She’s been a college professor/mentor for nursing students and director of nursing for multiple home health agencies in the District of Columbia. She’s worked on multiple health care research protocols and served as senior clinical lead on multiple projects and initiatives. Hannah is certified in Project Management, is a Certified Professional in Healthcare Quality (CPHQ) and a Certified Professional in Patient Safety (CPPS).Digitalization ensures the safe and efficient transfer and parsing of health care data between providers. Patients benefit, clinics benefit, clinicians can spend more time with patients. And improvements in data transfer and parsing reveal more population data than ever before, which uncovers gaps in health equity. And with that population data, researchers can start to reverse deficiencies and ensure better health care for all.Josh Hetler is Chief Operations Officer at DataLink and an expert in the potential revelations of supplemental data. Josh has over a decade of experience developing software products for advancing value-based health care. At DataLink, he’s held management, director and vice president positions, successfully building strategies that impact customer adoption and engagement. Josh was interviewed live and in person at NCQA’s 2nd annual Health Innovation Summit, in October 2023 in Orlando, Florida.

In this episode of Inside Health Care, we present two interviews that each ask really basic, yet complex, questions about health care.The first question: Why are patient alcohol and substance use issues so often overlooked in primary care? This interview will not only answer that question: it will point patients and providers in the right direction: toward adoption of universal alcohol screening and follow-up. Three experts remind us that there is help to implement evidence-based alcohol health care—free resources from NCQA and the National Institute on Alcohol Abuse and Alcoholism [NIAAA], part of the National Institutes of Health [NIH].At NCQA’s second annual Health Innovation Summit, we interviewed Dr. Thekla Brumder-Ross, Dr. Katharine Bradley and Dr. Laura Kwako.Dr. Thekla Brumder-Ross is a clinical psychologist and national leader of addiction medicine. In her 14 years at Kaiser Permanente, Thekla led and implemented large-scale practices and policies in addiction medicine, treatment protocols and primary care behavioral health integration. Notably, she led the addiction medicine leaders of operations and research across the Kaiser Permanente Enterprise, facilitated the spread of the “screening, intervention and referral to treatment” methodology known as “Alcohol as a Vital Sign” across eight Kaiser markets, and developed a national “harm reduction” strategy. Thekla currently provides strategic consultation to the NIAAA.Dr. Laura Kwako is chief of the Treatment, Health Services, & Recovery Branch in the Division of Treatment and Recovery at the NIAAA. Her office supports research in broad categories, including behavioral health treatments, translational research and innovative methods and technologies across the continuum of care.Her work also focuses on under-served populations, including NIH-designated health disparity populations, individuals with co-occurring disorders and fetal alcohol spectrum disorders. During her time at NIAAA, Laura has been involved in development of the Healthcare Professional’s Core Resource on Alcohol and the Addictions Neuro-clinical Assessment. She received her PhD in Clinical Psychology from Catholic University in Washington, DC.Dr. Katharine Bradley is a primary care general internist, and her research on unhealthy alcohol use and opioid use disorder has included developing trials of implementation of alcohol screening, brief interventions and shared decision making for alcohol use disorder across primary care clinics. She recently received NIAAA funding for the SIP trial, the full title of which is Systematic Implementation of Patient-Centered Care for Alcohol Use Trial: Beyond Referral to Treatment.Drs. Brumder-Ross, Kwako and Bradley collectively strive to link substance use disorders and treatment to behavioral health, which they see as just one part of a “whole health” approach to clinical medicine. We discussed some amazing tools now available to incorporate screenings for alcohol or drug use into mainstream primary care assessments. And those tools, by the way, take advantage of NCQA HEDIS measures. But let’s hear it from them.Some resources discussed in this interview:The NIAAA Alcohol Healthcare Roadmap: A simple workflow that plans and providers can adaptHealth plans can adopt the NCQA HEDIS measure on Alcohol Screening and Follow Up – now publicly reportable, bringing potential financial incentives to health plansImplementation guides available in Core Additional LinksNCQA resources for patient screeningFree training from NIH: NIAAA’s Healthcare Professional’s Core Resource on AlcoholThe other question: Why is it so hard to develop a health care coordinator service for patients at the local level? It’s something most of us could use: a helper to walk with us through a health journey, advise us in a crisis and make sure we get all the tests and records we should have.Taylor Justice is a U.S. Army veteran and co-founder of Unite Us. Unite Us provides end-to-end solutions that establish a new standard of care that identifies and predicts social care needs in communities, helps enroll people in services and leverages meaningful outcomes data to drive community investment. With services extending to at least 44 U.S. states, Unite Us creates accountable coordinated-care networks, interconnecting providers of social services to reduce the cost of care by integrating ALL social determinants of health.

In this episode, we explore a much-discussed Inside Health Care topic: interoperability. Within the process of health care digitalization, interoperability deals with the multi-lane, multi-directional transfer of electronic health records, or EHRs. But more and more, in that transfer process, companies discover data they hadn’t considered using, data needing refinement, and data that tells stories of patients being overlooked and left behind.In the first interview, my guest and I discuss the best way to smoothe the road to health equity: form a patchwork of different types of health care companies that can safely and efficiently shepherd data along the patient journey. Later, I co-interview a team that discovered a disparity gap and closed it—permanently. Their secret? Ask the community how to reach those patients.Mo Weitnauer is MRO’s Chief Product Officer. She drives its product strategy and roadmap. Throughout her high-level career, Mo has helped develop tech-based strategies for managing medical costs and patient bills, trying to even things out for both sides while still striving to advance care quality.Mo graduated with a bachelor’s degree in Biochemistry and Economics from Smith College, and she got her master’s degree in Health Policy and Management from Harvard’s T.H. Chan School of Public Health.Next, we hear a success story from a team from WellSpan Health, a health care that found a gap in health care equity and nailed down a solid and sustainable solution.Jenna Jansen is Senior Director of Quality at WellSpan Health. She earned her BS and MPH degrees from West Virginia University. She is a Fellow of the American College of Healthcare Executives and also a CPHQ.Jodi Cichetti is Vice President of Quality, Patient Safety and Infection Control and Prevention at WellSpan Health.  She’s an RN with a background of working in the ICU. She holds an MS in Health Systems Management from the University of Baltimore, and her certifications include, among others, a CPHQ, a.k.a. she’s a Certified Professional in Healthcare Quality.Jenna and Jodi presented a session at the Health Innovation Summit titled “STOP, Collaborate, & LISTEN! Improving Equitable Access to Care”. In the interview, they told the story of how their research revealed a gap in care delivery. Using various analytical tools including NCQA’s breast cancer screening measure, part of our HEDIS set of measures, they discovered a disparity among Spanish-speaking patients.

In this episode, we hear clips from four interviews recorded live at NCQA’s 2nd annual Health Innovation Summit.Parker Holcomb is Chief AI Engineer at Elevance Health. At NCQA’s 2023 Health Innovation Summit, he participated in a session titled “Building Trust in Clinical Data for Value-Based Care”. Parker stands at the forefront of data quality, constantly seeking to perfect data quality standards, all towards closing gaps in health equity. So how do professionals and technologists align the movement toward digital health transformation in the direction of value-based care?Dr. Joseph Betancourt is president of the Commonwealth Fund. One of the nation’s preeminent leaders in health care quality, Dr. Betancourt formerly served as senior vice president for Equity and Community Health at Massachusetts General Hospital (MGH), overseeing a number of entities including the Center for Diversity and Inclusion.A prolific author, lecturer, and board-certified internist who focuses on Spanish-speaking and minority populations, Dr. Betancourt is also an associate professor of medicine at Harvard Medical School. This is notable for this interview, as he earned his MPH from Harvard with one of the first classes in the Commonwealth Fund–Harvard University Fellowship in Minority Health Policy.At the 2023 NCQA Health Innovation Summit, he led a session titled “Pursuing the North Star: A high performing, equitable health care system”. And as you’ll hear, increasing diversity among health care professionals and rebuilding the trust of historically under-served patients are just two of a myriad of ingredients necessary to right the ship on the journey to Health Equity.Next, we hear a success story from a team from WellSpan Health, a health care that found a gap in health care equity and nailed down a solid and sustainable solution.Jenna Jansen is the Senior Director of Quality at WellSpan Health.Jodi Cichetti is Vice President, Quality and Patient Safety, at Wellspan Health.Jenna and Jodi presented a session at the Health Innovation Summit titled “STOP, Collaborate, & LISTEN! Improving equitable access to care”. In the interview, they told the story of how their research revealed a gap in care delivery. Using various analytical tools including NCQA’s breast cancer screening measure, part of our HEDIS set of measures, they discovered a disparity among Spanish-speaking patients.Christopher J. King is the inaugural Dean of the School of Health and former Chair of the Department of Health Systems Administration at Georgetown University in Washington, DC. An academic administrator, associate professor, and strategist, who is board certified in healthcare, Dr. King’s writing and teaching focus on the intersection of institutional racism, social determinants of health, and healthcare administration. And he envisions a world in which health status cannot be predicted by race, social class or place of residence.At this year’s NCQA Health Innovation Summit, Dr. King joined the dais in a session titled “No Quality without Equity”. In this clip from our interview, Dr. King talks about race-based clinical data in health care. And in his view, the use of this data is doing more harm than good.Stay tuned for more information about NCQA’s next Health Innovation Summit, set for Nashville, October 31-November 2, 2024. For more, go to https://www.ncqasummit.com.

In this episode of “Inside Health Care,” we meet two guests, in two interviews. Our first guest advocates for birth, racial and gender equity, driven by her own distressing experiences as a patient. Our second guest developed effective ways to implement virtual care on a large scale to improve equity and representation for rural communities.Sinsi Hernández-Cancio, JD, is a vice president at the National Partnership for Women & Families, where she leads the Health Justice team. Born in Puerto Rico, Sinsi is a national health and health care equity policy and advocacy thought leader dedicated to advancing equal opportunities for women and families of color. The Partnership worked with health care experts and partner organizations to develop a report that includes recommendations for improvement in resolving gaps in health equity that executive leaders can tailor to their organizations.Debbie Welle-Powell, MPA, is CEO of DWP Advisors and an Adjunct Professor at the University of Colorado Executive MBA. But Debbie is best and widely known in the health care world as the former Chief Population Health Officer at Essentia Health. Headquartered in Duluth, Essentia is an integrated delivery system of 14 hospitals and 1,500 providers spanning the states of Minnesota, North Dakota and Wisconsin. Debbie designed, built and operationalized Essentia’s $2.5 billion transition from a primarily fee-for-service model of care to one that focuses on value.Later in our “Fast Facts” segment, we observe Breast Cancer Awareness month for October 2023. We discuss the CDC’s guidance on how to help people with cancer "Stay Mentally and Emotionally Healthy.” We also discuss NCQA’s Breast Cancer Screening HEDIS measure, which assesses women 50–74 years of age who had at least one mammogram to screen for breast cancer in the past 2 years.

In this episode of “Inside Health Care,” we take a look back at what we’ve learned since the pandemic hit over two years ago. We first chat with an upcoming star speaker at NCQA’s 2023 Health Innovation Summit on what we’ve garnered from the growth of telehealth in remote medicine. Then in our second interview in this episode, we discuss the public’s conflict with immunization and new strategies on encouraging vaccination.Dr. Leslie Eiland is an Associate Professor of Medicine in the Department of Internal Medicine, Division of Diabetes, Endocrinology & Metabolism at the University of Nebraska Medical Center. She is Medical Director of Patient Experience and Digital Health at Nebraska Medicine, and has been Medical Director of the endocrine telehealth program there since 2014. The program provides care via telehealth to eight rural community hospitals in Nebraska and Iowa. Dr. Eiland’s clinical areas of interest and expertise are remote delivery of endocrine care and providing endocrine support for primary care providers in rural communities.For our second interview, we wonder: what have we learned from the pandemic? With backs up against the wall and clinical care pushed to capacity, 2023 was a time of reflection...and re-invigoration. In this interview, hosted by Dr. Sepheen Byron, Assistant Vice President, Performance Measurement at NCQA, you’ll hear about one such effort to see what we’ve learned about, and gain new insights into approaches to care, from review of pandemic care. In this case, we focus on Adult Immunization and improving adult immunization rates.A panel of experts, including partners from NCQA, convened in June of 2023 for a roundtable discussion on adult immunization. They not only discussed clinical guidelines and approaches to better health. They considered simple human behavior: how to rebuild trust with patients and ultimately find new ways to encourage them to vaccinate. In September 2023, NCQA released a white paper summarizing the roundtable’s discussions and their conclusions.Megan Lindley, MPH, is the adult vaccination Team Lead of the Applied Research, Implementation Science, and Evaluation Branch in the Immunization Services Division of the CDC. Her areas of research interest include immunization law and policy, adult immunization quality measurement, vaccination in pregnancy and healthcare personnel vaccination. She was an active member from 2012-2019 and a co-chair from 2018-2019 of the National Adult and Influenza Immunization Summit’s Quality Measures Workgroup, which developed two immunization quality measures that were added to HEDIS in 2019: a measure of routine adult vaccination and a composite measure of vaccination of pregnant women. Ms. Lindley has authored or co-authored over 100 peer-reviewed publications.In our Fast Facts segment, we observe September’s Prostate Cancer Awareness Month with important information from the CDC on symptoms and screening. We also discuss one of a number of NCQA’s cancer-related HEDIS screening measures. Colorectal Cancer Screening, which we call C-O-L or C-O-L-E, assesses adults 50–75 who had appropriate screening for colorectal cancer with any of a number of tests, including a colonoscopy every 10 years, computed tomography colonography every 5 years and a stool DNA test every 3 years.

In this episode of “Inside Health Care,” we talk interoperability with a cardiologist who helped develop a new standard for data records exchange. Fast Healthcare Interoperability Resources, a.k.a. FHIR, can improve efficiencies in use and transfer of electronic health records. It can ease pressure on medical staff while also improving health equity measurement.In our discussion with Dr. James Tcheng, we focus on the CardX Hypertension Project. CardX, or cardiovascular data exchange, was launched in 2022 by the University of Nebraska Medical Center’s Center for Intelligent Heath Care. The project stems from the greater CodeX FHIR Accelerator project. The project seeks to use FHIR as a standard for data transfer and parsing. The project’s stated objective is to “facilitate the communication of hypertension management data between clinicians and patients to increase the proportion of individuals with hypertension who are treated to goal.”Our guest is Dr. James Tcheng, cardiologist and professor of Family Medicine and Community Health at Duke University’s School of Medicine. In addition to his work with patients, his research ranges from developing therapies for cardiovascular disease to use of A.I., I.T., and clinical informatics to improve efficiencies in the delivery of care. I’m pleased to say that Dr. Tcheng will be presenting a session on the CardX FHIR Accelerator at NCQA’s annual Health Innovation Summit, coming October 2023.Later on in our “Fast Facts” segment, we observe September’s Healthy Aging Month in the U.S. with information about osteoarthritis. We also give a rundown of NCQA’s HEDIS OMW measure, namely Osteoporosis Management in Women Who Had a Fracture. This measure assesses women 67–85 years of age who suffered a fracture and who had either a bone mineral density test or a prescription for a drug to treat osteoporosis in the 6 months after the fracture.

In this episode of “Inside Health Care,” we chat with a prominent NCQA board member about flipping fee-for-service models to value-based models, all in order to ease digital transformation. Then, we talk about the challenges and true rewards of pursuing Credentialing Accreditation. Dr. Craig Samitt is the CEO and Founder of ITO Advisors, an advisory and investment firm committed to value transformation of the health care industry. Dr. Samitt sits on many boards in addition to NCQA’s Board of Directors. He also serves as a strategic advisor to federal agencies, public and non-profit health plans and numerous digital health and care delivery organizations.At the Health Innovation Summit, Dr. Samitt will panel alongside NCQA President Peggy O’Kane and other experts. In a session called “Payment Models and Digital Transformation,” they’ll discuss the opportunities and challenges associated with digital transformation in a fee-for-service landscape. Bill Vargo is Program Manager in the Northwestern Medicine Physician Network of Northwestern Medicine. He helped lead Northwestern Medicine through NCQA’s Credentialing Accreditation process, and he wanted to share with us the need for this program, the rewards of simply going through the evaluation and how Northwestern did it. NCQA Credentialing Accreditation helps improve credentialing and protects consumers by ensuring a consistent, effective and diligent credentialing process. It provides a framework for organizations to implement industry best practices that help them efficiently credential and re-credential health care professionals.Later in our Fast Facts segment, we observe August as National Breastfeeding Month with some data on federal legislation regarding breastfeeding in the workplace. This information is provided by an independent nonprofit organization, the United States Breastfeeding Committee. We then describe NCQA’s Prenatal and Postpartum Care HEDIS quality measure, also known as PPC.

In this episode of “Inside Health Care,” we talk digital transformation with a prominent medical informaticist. Then, we hear a conversation on NCQA’s long-term services and supports programs, a.k.a. LTSS, from a long-time accredited managed care supporter.Dr. John Glaser is Executive in Residence at Harvard Medical School Executive Education. Previously he was Chief Executive Officer of Siemens Health Services. He is former Chair of the Global Agenda Council on Digital Health in the World Economic Forum, and former Senior Advisor to the Office of the National Coordinator for Health Information Technology. He’s also a member of NCQA’s Board of Directors.Dr. Glaser will also be at NCQA’s second annual Health Innovation Summit in October 2023. In addition to helping open the Summit, he’ll sit on a C-suite panel alongside NCQA President Peggy O’Kane and other industry leaders, discussing, among other things, the transition to a digital health ecosystem.Centene is the largest Medicaid Managed Care Organization in the U.S., as well as the largest carrier on the Health Insurance Marketplace.Nicole McLean is an accreditation manager for Centene, and she spends much of her time working with NCQA on our LTSS programs. But which services are included in LTSS? What could they be? Well, as Nicole will tell you, in order to evaluate which services and supports people need, you first have to learn about...the patient.Later in our Fast Facts segment, we observe August as National Immunization Awareness Month. First, we present some tips from the CDC for providers' offices on how to talk about vaccinations to young patients and their families. We also mention NCQA's HEDIS "Childhood Immunization Status" measure.

In this episode, we talk with two leaders of an amazing NCQA partner company, Cozeva, while revisiting one of NCQA’s cutting edge digital products, our Data Aggregator Validation program [DAV]. Cozeva, a member of the original program cohort, is an integrated, comprehensive population health platform.Our Data Aggregator Validation program now forms the backbone of Cozeva’s services. Cozeva currently provides health care data solutions to nearly 37,000 providers across 16 states. For more details on NCQA's data analysis work, check out our Data Measures Roadmap.Dr. Khanh Nguyen is Chief Executive Officer of Cozeva. Khanh has a doctorate from the University of California San Francisco School of Pharmacy, focusing on health policy and management. She has over 15 years of experience in creative payer-provider collaborations. Khanh is an expert in data crunching, discussing how improving and easing the flow of health care data will then improve efficiency for both payers and providers.Dr. Rosh Singh is Cozeva’s Chief Technology Officer. In his over eight years with Cozeva, Rosh was previously VP of Product Management, and before that, Director of Analytics. He has a PhD in Biomedical Engineering from Cornell and over 15 years experience combining product management with A.I. and machine learning. He creates what he calls “decision science,” finding hard- and soft-tech solutions that support multi-billion-dollar transactions.Later on in our Fast Facts segment, we observe Gastroparesis Awareness Month with important information that could save a life. The episode also discusses NCQA's Colorectal Cancer Screening measure [COL], featured as part of our HEDIS package of quality health care measures.

In this episode, we’re focusing on NCQA’s PCSP—Patient-Centered Specialty Practice Recognition program. As noted on our website, the PCSP Recognition program focuses on coordinating and sharing information among primary care clinicians and specialists. It requires clinicians to organize care around patients—across all clinicians seen by a patient. Patients and their families or other caregivers are included in planning care and considered partners in managing conditions.Specialty practices that earn NCQA’s PCSP Recognition communicate more effectively with primary care, integrate services better with primary care and improve the quality of their care. Patients see the difference through reduced costs, better data and records management, improved identification and oversight of chronic conditions, and more face time with a more satisfied medical staff.For this interview, we found one of our greatest advocates of the PCSP Recognition program, an extremely busy and dedicated medical team from Providence Heart Institute in Portland, Oregon. A number of years ago, they saw the need for PCSP, found solutions that worked conclusively and spread the word throughout their company about the effectiveness of the patient-centered specialty practice model of care. Xiaoyan Huang, MD, Chief of Clinical Cardiology, leads clinical operations and care transformation for advanced heart failure, electrophysiology, general cardiology and interventional cardiology subspecialties. Danielle Christensen is Clinical Program Manager at the Providence Heart Institute in Oregon. With experience in both ambulatory and acute care settings, Danielle’s expertise spans business development and strategy, change management and development, and the optimized exchange of electronic health records. Dr. Huang and Danielle led a session at NCQA’s first Health Innovation Summit in the fall of 2022. And they ran a fascinating and informative training webinar which is still available for download on our education website. The title of their course: “CCE Quarterly: Building with a Blueprint: Taking a Patient-Centered Specialty Practice from Medical Neighborhood to High Performing Network.” The interview is hosted by NCQA’s Senior Vice President for Product and Customer Operations, Lori Ferguson. Later on, in our Fast Facts segment, we observe National Minority Mental Health Awareness Month with important stats to share with colleagues and community. Among many of our products and measures addressing behavioral health needs, we mention is NCQA’s “Managed Behavioral Health Organization Accreditation” or MBHO, an important accreditation for employers.

On this episode of Inside Health Care, we talk Medicaid with a large, equity-focused provider about the end of the Fed’s pandemic-related emergency Medicaid provisions. Following that, a chat with one of our 2022-2023 PCMH Certified Content Expert Quality Award winners. Later on, some fast facts for you in observance of World Hepatitis Day.Elevance Health, a large multi-state health insurance provider, is the largest managed care company in the Blue Cross Blue Shield Association. In September of 2022, an Elevance Health subsidiary, Simply Healthcare Plans of Florida, became one of the first health care organizations in the U.S. to earn accreditation in NCQA’s Health Equity Accreditation Plus program.We interview Elevance Health Medicaid President Aimée Dailey alongside Staff Vice President for Medicaid Whole Health Kalunde Wambua to find out more about the company’s continued commitment to Equity improvement.We also talk with one of NCQA’s 2022-2023 PCMH Certified Content Expert Quality Award winner, Susanne Campbell, Senior Program Administrator for the Care Transformation Collaborative of Rhode Island. We talked about the challenges of getting people on board with quality measurement. And we learned that, as measurement improves, customer focus improves, and health delivery becomes more efficient, all leading to solutions for resolving historic gaps in health equity.Finally, in our Fast Facts segment, we observe the World Health Organization’s World Hepatitis Day, scheduled annually every July 28th. We include resources from the U.S. Department of Health and Human Services alongside an article from the NIH. Hepatitis awareness includes further reminders for childhood immunization, something NCQA measures in our HEDIS Measures package called Childhood Immunization Status, or C-I-S. The measure calculates the rates for a number of childhood vaccines and vaccine combinations. Among the vaccines in the list, alongside DTaP, MMR, and the flu, are vaccines for both Hep A and Hep B.We're also proud to announce that Inside Health Care won two media industry awards, both announced in June 2023. We won a Merit award from the Digital Health Awards. We've also been named a Gold Winner 2023 by the Hermes Awards. Thanks to all our interviewees and leadership staff at NCQA for their support along the way.

On this episode of Inside Health Care, we celebrate Pride Month with discussions on gender health equity, sexual orientation and gender identity health care quality issues, and health care access and representation for the LGBTQIA+ community. Later, some tips on improving the provider experience for transgender patients.Dr. Alex Keuroghlian is an expert in Sex- and Gender-Informed Medicine and Sexual and Gender Minority Health Care. As a psychiatrist, Dr. Keuroghlian’s work often centers on patients suffering from post-traumatic stress disorder, or PTSD, especially within the LGBTQIA+ community. They hold numerous leadership and teaching positions at Massachusetts General Hospital and Harvard Medical School. They also support and educate health care centers and clinicians in gender equity with their leadership as Director of the Division of Education and Training at The Fenway Institute, and Principal Investigator of the National LGBTQIA+ Health Education Center, a HRSA-funded cooperative agreement to improve health care for LGBTQIA+ people at health centers around the country.NCQA Senior Research Scientist for Health Equity Dr. Rachel Harrington discusses gender-equity needs and perspectives in health care. Her team develops improvements to NCQA's HEDIS measures updates. We discuss why it's been so difficult to gather health data on LGBTQIA+ populations.Later in our Fast Facts segment, we include tips via the CDC from the GLMA on improving the provider experience for transgender patients.

On this episode of Inside Health Care, we feature two interviews celebrating winners of two different NCQA awards: a NCQA 2022 Health Innovation Award and a 2022-2023 PCMH CCE Quality Award Winner. Later in the show in our Fast Facts segment, we discuss gender equity-related health care terminology.In our first interview, we talk with Dr. Ava Jones, PhD and RN, the Director for Health Equity and Accreditation at United Health Care Community and State’s Florida Plan. Dr. Jones' workplace won an NCQA 2022 Health Innovation Award for the “UnitedHealthcare Community Plan of Florida Housing Navigation Program.” A healthcare navigator assists plan members with advice or suggestions on how to pursue a medical issue affecting them or their family. Dr. Jones explains the nature and importance of a housing navigator.NCQA PCMH Recognition is like a seal of approval for quality assurance. A health care practice that earns that seal can be trusted for their dedication to delivering quality care—which means they’re dedicated to their patients. And having a Certified Content Expert, or CCE, almost guarantees a practice will continue its dedication to excellence for years to come.NCQA’s 2022–2023 PCMH Certified Content Expert Quality Award Winner Deneane Anderson works for the Capital Area Health Network, also known as CAHN, in Richmond, VA. She’s been in the medical field for the past 15 years and has been a patient advocate for the past 14 years at CAHN and operates as the Transformation Manager of the PCMH Team at CAHN. Click the link for more information about becoming a PCMH CCE.Our Fast Facts segment in this episode celebrates Pride month with background on federal protections for those people identifying as LGBTQ+, info on gender-affirming care and gaining health insurance. We then focus on NCQA’s efforts to update HEDIS measures to include language for Sexual Orientation and Gender Identity.

On this episode of Inside Health Care, we talk about acupuncture, yoga and a host of other “alternative” therapies with a health leader in the U.S. government. After that, we explore a newly announced breakthrough in digitalization exploration with NCQA’s Chief Technology Officer.Our first guest is one the foremost experts in the U.S. on integrative medicine. He answers some difficult questions. How have some alternative therapies become legitimized? And what are the risks of unregulated therapies?Benjamin Kligler, MD, MPH, is Executive Director of the Office of Patient Centered Care and Cultural Transformation (OPCC&CT) at the Veterans Health Administration. He is a board-certified family physician, working as a clinician, educator, researcher and administrative leader in the field of complementary and integrative medicine.At NCQA’s 2023 Quality Talks, Dr. Kligler talked about “whole health” and how it relates to his work.In our next interview, NCQA Chief Technology Officer Ed Yurcisin breaks down our newest development in digital health, our newly-announced requirements and open source software for interpreting and executing clinical quality language (CQL) so any organization or software developer can use HEDIS Digital Content Services.Later in Fast Facts, we observe Osteoporosis Awareness and Prevention Month. We also discuss the NCQA has HEDIS measure, Osteoporosis Screening in Older Women, that assesses the percentage of women 65–75 years of age who receive osteoporosis screening.